最新difficult airway management[困难气道](64)教学讲义ppt课件.ppt

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1、DIFFICULTAIRWAYMANAGEMENT[困难气道管理](64)IFYOUGETACALLTOATTENDTHISCASECHECKYOURPULSERATE2DEFINITIONAmericansocietyofAnesthesiologist(ASA)suggested(difficulttoventilate)thatwhensignofinadequateventilationcouldnotbereversedbymaskventilationoroxygensaturationcouldnotbemain

2、tainedabove90%or(difficulttointubate)ifatrainedAnaesthetistusingconventionallaryngoscopetake’smorethan3attemptsormorethan10minutearerequiredtocompletetrachealintubationAnatomicalfactorsaffectingLarangoscopyShortNeck.Protrudingincisorteeth.Longhigharchedpalate.Poormo

3、bilityofneck.IncreaseineitheranteriordepthorPosteriordepthofthemandibledecreaseinAtlantoOccipitaldistanceBasicairwayevaluationinallpatientsPreviousanaestheticproblemsGeneralappearanceoftheneck,face,maxillaandmandibuleJawmovementsHeadextentionandmovementsTheteethando

4、ro-pharyngxThesofttissuesoftheneckRecentchestandcervicalspinex-rays8/3/20218Dr.BinnionsLemonLaw:Aneasywaytoremembermultipletests…Lookexternally.Evaluatethe3-3-2rule.Mallampati.Obstruction?Neckmobility.L:LookExternallyObesityorverysmall.ShortMuscularneckLargebreastsP

5、rominentUpperIncisors(BuckTeeth)RecedingJaw(Dentures)BurnsFacialTraumaStridorMacroglossiaE-Evaluatethe3-3-2rule3fingersfitinmouth3fingersfitfrommentumtohyoidcartilage2fingersfitfromthefloorofthemouthtothetopofthethyroidcartilage11M-MallampaticlassificationClass-1Cla

6、ss-11Class-111Class-1Vsoftpalate,fauces;uvula,anteriorandtheposteriorpillars.thesoftpalate,faucesanduvulasoftpalateandbaseofuvulaOnlyhardpalateCormack&LehaneGrading8/3/202113ValidityoftheTest(II)CormackGradeGr.1Gr.2Gr.3Gr.4Class1(73.8%)59.5%14.3%00Class2(19%)5.7%6.7

7、%4.7%1.9%Class3(7.14%)00.5%4.3%2.4%MallampaticlassTotal210patientsO:Obstruction?BloodVomitusTeethEpiglottisDenturesTumorsImpaledObjectsN-Neckmobility-MeasurementofAtlanto-OccepitalAngleThyroMentalDistanceMeasurefromupperedgeofthyroidcartilagetochinwiththeheadfullye

8、xtended.Ashortthyromentaldistanceequateswithananteriorlarynx.Greaterthan7cmisusuallyasignofaneasyintubationLessthan6cmisanindicatorofadiff